Frailty After Cancer Surgery Among Older Adults: A Geriatric Oncology Perspective
Authors: Samuel Dubé, Shabbir M.H. Alibhai
Journal: Journal of the National Comprehensive Cancer Network (2022)

T he older adult population has increased over the past several decades in Can- ada and most other industrialized countries.According to recent Canadian Cancer Statistics, 63% of people diagnosed with cancer in Canada are aged $65 years, representing approximately 144,000 Canadians. 1 Cancer care is complex, especially in older adults, for whom physicians need to weigh the higher level of comorbidity and age-related impairments, the risk of toxicity and complications with treatment, the prognosis related to cancer, and the remaining life expectancy independent of cancer.A poor understanding of the complexity of older adults could potentially lead to overtreatment or undertreatment; this could lead to poorer outcomes compared with younger patients. 2ome older patients are more prone to complications after cancer treatment; those patients are labelled as frail.Frailty is a complex, multidimensional, and cyclical state of diminished physiologic reserve that results in decreased resiliency and adaptive capacity and increased vulnerability to stressors.Multiple studies have shown a higher rate of postoperative complications and mortality among frail older adults in hospitals after oncologic surgery. 3Quality of life is an important matter for most older adults with cancer.A recent prospective study showed the feasibility of preserving quality of life through cancer surgery and the very limited role of chronologic age compared with frailty assessments in older adults with cancer. 4However, data are missing on important long-term outcomes in this population to guide decision-making regarding cancer treatments.Many older adults share priorities, such as wanting to stay at home, being independent as long as possible, and staying cognitively intact.These outcomes are not well studied in the context of cancer, but knowledge gaps are slowly being addressed.The article by Hallet et al 5 in this issue of the journal is a retrospective populationbased study in Ontario, Canada, evaluating the association between frailty and remaining alive and at home after cancer surgery among older adults.Among 82,037 patients included, 7.9% were considered frail using the Johns Hopkins Adjusted Clinical Groups frailty marker.This tool identifies 12 clusters of diagnoses within important geriatric domains, including nutrition and weight loss, cognition, mobility and falls, and social impairments, all collected retrospectively from several databases.The outcome of interest was time spent alive and at home after cancer surgery, meaning time until death or admission to a nursing home.The authors reported that patients with frailty had a significantly lower probability of remaining alive and at home 5 years after cancer surgery: 39.1% compared with 62.5% among those without frailty.After adjusting for multiple demographic and clinical variables, frailty remained associated with an increased risk of not remaining alive and at home after oncologic surgery.Importantly, these findings were consistent across multiple cancer sites.The findings regarding the association between frailty and the primary outcome are not surprising.The increased risk of not remaining alive and at home was the highest from 1 to 3 months after surgery (hazard ratio, 2.00; 95% CI, 1.78-2.24)and remained significantly elevated beyond 1 year.